Stress Associated With HFpEF but Not HFrEF?

Stress was linked to higher long-term risk related to heart failure with preserved ejection fraction (HFpEF), researchers found from the large REGARDS cohort.

People who reported feeling more stress had more incident HFpEF-related death and hospitalization over a median follow-up of 10.1 years compared with peers scoring zero on the Perceived Stress Scale (PSS) assessment:

  • PSS score 1-2: adjusted HR 1.37 (95% CI 1.00-1.89)
  • PSS 3-4: adjusted HR 1.42 (95% CI 1.04-1.95)
  • PSS ≥5: adjusted HR 1.41 (95% CI 1.04-1.92)

In contrast, stress had no discernable relationship with incident HFrEF events, reported Lauren Balkan, MD, of Weill Cornell Medical Center in New York City, during her presentation at a moderated poster session at this year’s virtual conference of the Heart Failure Society of America.

HFpEF is thought to be a progressive systemic disorder influenced by aging and key comorbidities, such as chronic kidney disease and obesity. It is possible that psychological stress is another one of those comorbid conditions, Balkan suggested.

“We already know that lifestyle factors, including emotional and psychological stress, contribute to heart failure via increased oxidative stress and activation of inflammatory and neurohormonal pathways,” Balkan said.

The study was based on the REGARDS cohort of more than 30,000 U.S. study participants, originally examined to evaluate geographic and racial disparities in stroke mortality.

The ongoing longitudinal study enrolled patients in 2003-2007. Participants underwent a baseline physical examination and reported detailed sociodemographic information, dietary patterns, and medication use. Subsequently, they were contacted by phone every 6 months for updates on hospitalizations and mortality.

Balkan’s group analyzed the 25,785 REGARDS patients (45% men, 40% Black, mean age 64 years) who were free of heart failure and had the four-item PSS completed at baseline.

This cohort was divided into quartiles by PSS score.

People in higher stress categories were more likely to be female, Black, and have income below $35,000 per year. They also exhibited more unhealthy behaviors (e.g., current smoking, alcohol use, and no exercise), and had a higher prevalence of comorbidities such as atrial fibrillation.

But interactions for age, sex, and income were not significant.

Limitations of the observational study include its reliance on self-reported measures and the assessment of stress at a single time point, Balkan acknowledged.

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    Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow


The REGARDS study was sponsored by the NIH.

Balkan had no disclosures.

Study coauthors reported ties to Amgen and Novartis.

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